A randomized clinical trial comparing physician-directed or fixed-dose steroid replacement strategies for incomplete dex
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ORIGINAL ARTICLE
A randomized clinical trial comparing physician-directed or fixed-dose steroid replacement strategies for incomplete dexamethasone dosing prior to docetaxel chemotherapy Tina Hsu 1,2 & Dean Fergusson 2,3 & Carol Stober 4 & Kelly Daigle 5 & Noorza Moledina 5 & Lisa Vandermeer 4 & Greg Pond 6 & John Hilton 1,2 & Brian Hutton 2,3 & Mark Clemons 1,2,3,4 & on behalf of the REaCT investigators Received: 24 April 2020 / Accepted: 18 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Prior to docetaxel chemotherapy, incomplete dosing of steroid premedication is common. The lack of standardized steroid replacement strategies can lead to variability in care and delays in starting docetaxel. Methods This randomized trial compared physician-directed with fixed-dose dexamethasone. Patients who had missed at least one dose of steroid premedication were randomized to physician-directed replacement (any choice of steroid, dose or route) or to dexamethasone 8 mg oral before starting docetaxel. The primary outcome was time from randomization to starting docetaxel. Secondary outcomes included rates of acute and delayed hypersensitivity reactions, fluid retention and skin toxicity. Results Of 60 eligible patients, 30 (50%) and 30 (50%) were randomized to physician-directed and fixed-dose arms, respectively. Overall tumour types: breast (42 [70%]), gastrointestinal (7 [12%]), prostate (7 [12%]) and lung (3 [7%]). Dexamethasone was most commonly incompletely taken with cycles 1 (28 [48%]) and 2 (13 [22%]) of docetaxel. Seven different replacement strategies were used in the physician-choice arm. Patients in the fixed-dose arm received docetaxel a mean of 21.2 (95% CI for the difference is 2.1 to 44.6) minutes earlier than the physician-choice arm (p = 0.033 Wilcoxon rank sum test or p = 0.073 two-sample t test). Median time to docetaxel was 47.5 vs 61 min (mean 62.2 vs 83.4 min) by arm, respectively. No significant difference in toxicity rates was observed. Conclusion While not meeting our predefined criteria of improving the time from randomization to starting docetaxel by 30 min, the fixed-dose replacement strategy reduced both the time to starting docetaxel and treatment variability. Fixed dosing with oral dexamethasone 8 mg should be the preferred standard of care. Registration www.clinicaltrials.gov NCT02815319 Registration Date June 28, 2016 Keywords Steroid dosing . Dexamethasone . Allergic hypersensitivity . Docetaxel chemotherapy
Introduction * Mark Clemons [email protected] 1
Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
2
Department of Medicine, The University of Ottawa, Ottawa, Canada
3
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
4
Cancer Research Program, Ottawa Hospital Research Institute, Ottawa, Canada
5
Department of Nursing, The Ottawa Hospital and the Ottawa Hospital Cancer Centre, Ottawa, Canada
6
Department of Oncology, McMaster University, Hamilton, Canada
Prior to the wide
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